非心脏手术行极量与次极量多巴酚丁胺负荷超声心动图试验阴性患者的心脏事件:静息室壁运动异常的意义  

Cardiac events in patients with negative maximal versus negative submaximal dobutamine echocardiograms undergoing noncardiac surgery: Importance of resting wall motion abnormalities

作　　者：Labib S.B. Goldstein M. Kinnunen P.M. Schick E.C. 苏显明 

机构地区：[1]Dept. of Ca rdiovascular Medicine, Lahey Clinic, Burlington, MA, United States,Dr.

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2005年第1期40-41,共2页

摘　　要：Objectives This study sought to evaluate the negative predictive value( NPV) of preoperative dobutamine stress echocardiography(DSE) in patients who fail to ac hieve target heart rate(HR) and assess the influence of resting wall motion abno rmalities(WMAs) without demonstrable ischemia on perioperative events. Backgroun d The prognostic value of a negative-submaximal DSE study before noncardiac sur gery is unknown. Methods Consecutive patients (n=429) who underwent surgery over a three-year period, preceded by DSE, were included. We compared perioperative event rates among those without inducible ischemia according to whether or not 85%age-adjusted maximum HR was achieved, and whether WMAs were present at rest . Results Of 397 negative DSEs, peak HR was < 85%maximum predicted in 62 (16%) . Most were receiving beta-blockers (77%). The average dobutamine and atropine doses were 48 μg/kg/min and 1.2 mg, respectively. Average HR was 115 beats/min (74%maximum predicted). Perioperative myocardial infarctions occurred more fre quently in patients with positive tests (3 of 32 <<9.4%>> vs. 7 of 397 <<1.8%>>; p =0.03) , but with similar frequency among the negative-maximal and negative-su bmaximal groups(6 of 335, 1.8%vs. 1 of 62, 1.6%, respectively). Accordingly, t he NPV was 98%in both subgroups. Events occurred exclusively in patients with W MAs at rest: 7 of 100 (7%) versus 0 of 297 (0%) (p < 0.0001). Conclusions In p atients undergoing preoperative DSE, failure to achieve target HR is not uncommo n despite an aggressive DSE regimen. A negative DSE without resting WMAs has exc ellent NPV regardless of the HR achieved. Patients with resting WMAs appear to b e at increased risk for perioperative events even without provokable ischemia.Objectives This study sought to evaluate the negative predictive value( NPV) of preoperative dobutamine stress echocardiography(DSE) in patients who fail to ac hieve target heart rate(HR) and assess the influence of resting wall motion abno rmalities(WMAs) without demonstrable ischemia on perioperative events. Backgroun d The prognostic value of a negative-submaximal DSE study before noncardiac sur gery is unknown. Methods Consecutive patients (n=429) who underwent surgery over a three-year period, preceded by DSE, were included. We compared perioperative event rates among those without inducible ischemia according to whether or not 85%age-adjusted maximum HR was achieved, and whether WMAs were present at rest . Results Of 397 negative DSEs, peak HR was < 85%maximum predicted in 62 (16%) . Most were receiving beta-blockers (77%). The average dobutamine and atropine doses were 48 μg/kg/min and 1.2 mg, respectively. Average HR was 115 beats/min (74%maximum predicted). Perioperative myocardial infarctions occurred more fre quently in patients with positive tests (3 of 32 <<9.4%>> vs. 7 of 397 <<1.8%>>; p =0.03) , but with similar frequency among the negative-maximal and negative-su bmaximal groups(6 of 335, 1.8%vs. 1 of 62, 1.6%, respectively). Accordingly, t he NPV was 98%in both subgroups. Events occurred exclusively in patients with W MAs at rest: 7 of 100 (7%) versus 0 of 297 (0%) (p < 0.0001). Conclusions In p atients undergoing preoperative DSE, failure to achieve target HR is not uncommo n despite an aggressive DSE regimen. A negative DSE without resting WMAs has exc ellent NPV regardless of the HR achieved. Patients with resting WMAs appear to b e at increased risk for perioperative events even without provokable ischemia.

关 键 词：负荷超声心动图 室壁运动异常 多巴酚丁胺 心脏事件 非心脏手术 阴性患者 预测价值 心肌缺血患者 β受体阻滞剂 次极 

分 类 号：R541[医药卫生—心血管疾病]